Health Protection (Coronavirus, Restrictions) (All Tiers) (England) (Amendment) (No. 2) Regulations 2020

Lord Bethell Excerpts

Wednesday 30th December 2020 Lords Chamber

Moved by

[Lord Bethell]

That the Regulations laid before the House on 17 December be approved.

Instrument not yet reported by the Joint Committee on Statutory Instruments.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)]

My Lords, despite all the pressure we are under, I would like to take a moment to celebrate some good news. The Government have today accepted the recommendation from the Medicines and Healthcare products Regulatory Agency to authorise Oxford University/AstraZeneca’s Covid-19 vaccine for use. This follows rigorous clinical trials and a thorough analysis of the data by experts at the MHRA, which has concluded that the vaccine has met its strict standards of safety, quality and effectiveness. We have hundreds of thousands of doses ready to go and 100 million on order—enough for everyone.

On 4 January, the NHS will start administering doses to a revised list that reflects many of the interventions by noble Lords in this Chamber in recent debates. While the vaccine project is an international collaboration, we should take a moment to recognise the contribution of the British life sciences sector and reflect that this easy-to-administer, affordable and mass-produced vaccine offers Britain a way out of this disease, and will make a huge impact on the global response.

But, in the meantime, news from the front line remains grim. While the November national restrictions drove cases down in most areas, it is now clear that cases are rising again at a worrying rate. Across the whole country, cases have risen 57% in the last week, driven by the highly transmissible new variant. The number of people testing positive for Covid-19 has increased rapidly and a growing proportion have the new variant. Data from 29 December showed that there were an enormous 53,135 new Covid cases across the UK—half with the new variant—an increase of 272,551 over seven days. NERVTAG has concluded that the new variant demonstrates a substantial increase in transmissibility, of around 70%, and the R value appears significantly higher, with initial estimates at 0.39 and 0.93 higher—a massive margin in epidemiological terms.

In September, we introduced the tiering framework, which we built upon and refined in December. This is designed to provide a flexible and responsive system, which allows areas to move up and down the tiers as case rates change. It proved effective, with many areas containing transmission. Despite our efforts, the new variant has changed things. It forced us to establish the new tier 4 and to move regions, such as London and the majority of the south-east, into this higher tier.

The good news is that there is no evidence, at this stage, to suggest that the new variant of the virus is likely to cause more serious disease, that our current testing regimes will not detect it or that a vaccine will not respond effectively to it. For this, we give thanks. But the bad news is that there is no data showing that it causes less disease. The new variant accounts for 60% of cases in London and is growing around the country. As always, we see that increased infections lead to increased hospital admissions and loss of life. I need hardly remind noble Lords that this is a time when the NHS faces enormous challenges from winter pressures, its commitment to elective procedures and now the new variant. That is why we introduced the tier 4 stay-at-home measures we are debating today.

As in the November lockdown, people in tier 4 areas must stay at home and not travel out of tier 4. They may leave only for a limited number of reasons, such as work, education or caring purposes. People elsewhere are advised to avoid travelling into tier 4 areas. In tier 4, support and childcare bubbles are the same as in all other tiers. However, all non-essential retail and indoor entertainment will close. International travel is restricted to business trips. The clinically extremely vulnerable in tier 4 areas should do as they did in November and stay at home as much as possible, except to go outdoors for exercise or to attend health appointments.

However, we have listened to noble Lords in this Chamber and the public about what is important for the way people go about their daily lives. Unlike under the November restrictions, communal worship and a wide range of outdoor recreation are permitted. The restrictions imposed in tier 4 areas are hard, but necessarily so. They are designed to reduce transmission of this new variant, so that the NHS is not overwhelmed and we can return to normal as quickly as possible. These stricter rules are in line with other major European countries.

In addition to Greater London, other areas have now moved into tier 4, including Cambridgeshire, the rest of Essex, Norfolk, Suffolk, West Sussex, Hampshire, Southampton, Oxfordshire and Waverley. These changes took place on Boxing Day. We have balanced the economic impact of greater restrictions on business with measures to protect public health. These restrictions impact business in the short term, which is hugely regretful, but we should be clear that they will be economically beneficial in the long term, because we will get back to normal quicker. We are also mitigating the short-term impact through financial support schemes.

On 19 December, we had to take the horribly difficult decision to reduce the Christmas bubble exemption. I know that this meant that the majority of us could not celebrate in the way we would choose. However, given the increase in transmission rates, it would have been irresponsible and reckless to provide too great a window for increased social mixing and the inevitable increase in transmission that that brings.

Therefore, the Government had to ask people across the country to make further restrictions to their Christmas plans. Although this period has been difficult, we now have clear hope. With the rollout of the vaccine under way, we can start to plot our path out of the pandemic with greater certainty, but it is precisely because of this hope that we cannot give up now. That is why my right honourable friend the Secretary of State for Health and Social Care will make a Statement in the House of Commons later this afternoon, addressing future tiering arrangements in response to the new variant. My right honourable friend the Secretary of State for Education will make a Statement in the other place on the return of schools and universities. The sacrifices we make now are crucial to getting back to normal and ensuring that, next year, Christmas will be much more normal for every family in the country.

I commend the hard work of the NHS teams on the front line, including our Chief Medical Officer, scientists developing vaccines and other therapeutics, and those in the life sciences industry seeking to mitigate the impact of this epidemic. I also express the sympathy of us all to those feeling under pressure of any kind—financial hardship, domestic strife, health concerns, educational worries, mental health pressure or just the worry for loved ones and an uncertain future. To all those, I say that there is light at the end of the tunnel. With new scientific advances being made every day, we are taking concrete steps but, in the meantime, we must dig deep. The end is in sight and, until science can make us safe, it is our duty to put in place these new rules, which will help us to keep this virus under control. I commend these regulations to the House.

--- Later in debate ---

[Lord Bethell (Con)]

My Lords, I am enormously grateful to noble Lords for an informed, thoughtful and passionate debate. These regulations are incredibly important, but they are clearly not enough to battle the growth of Covid in recent weeks, and the noble Lord, Lord Harris, was entirely right to spotlight the situation in London, which is particularly acute. In Havering, there is a prevalence of 1,500 per 100,000. I remember being surprised when somewhere hit 200, and we used to be happy with 400—1,500 is an astonishing number. I fear that that is what we are looking at, at the moment, and that is the seriousness of the situation we have to face up to.

Some noble Lords have suggested that we are not doing enough, and I will answer a few questions in that area. As noble Lords who have frequently attended these debates will know, we could not have been more committed to our testing regime. In the last reported week, from 10 to 16 December, 92.6% of contacts were reached, 93.9% of pillar 1 tests were within 24 hours and 91.1% of care home tests were within three days. Some 2,293,012 tests were done in that week. That is a colossal number, which reflects an enormous commitment.

The noble Lord, Lord Berkeley, is quite wrong when he describes the project in the Channel Tunnel as chaotic. It was a remarkable achievement, and I do not think that any other country could have pulled it off: 30,000 tests were brought together incredibly quickly on the roadside, with a multinational team of hauliers, under the most difficult circumstances. This helped to get trade moving, and I personally pay tribute to colleagues from the DfT, the military, local police, the test and trace programme and all those who made that possible. I also pay tribute to those who are pulling together tracing partnerships and the community testing regimes over the Christmas period; they have made enormous progress.

A number of noble Lords have quite rightly asked about volunteers and whether we could or should be using them more. I reassure noble Lords in the Chamber that we are absolutely working our hardest to make use of volunteers where we can. A number of noble Lords have asked about administrative problems, and I reassure noble Lords that NHS Resolution has put in place clinical negligence schemes for coronavirus under the terms of the Coronavirus Act, which we debated here at the beginning of the year, and Covid-19 has been added to the Vaccine Damage Payments Act.

NHS volunteer responders have delivered 1 million tasks to 123,455 unique clients; that is the work of 360,000 NHS responders. The St John Ambulance, which has had an absolutely massive impact, has delivered 200,000 hours of support and has very helpfully been involved in training 30,000 people for the administration of the vaccine. It is very much our intention to make use of that valuable resource. Of the 45,000 on the Bringing Back Staff team at the NHS, 2,700 have already been used, and many more will be deployed right now.

In relation to the vaccination, I reassure noble Lords that the authorisation today is a complete game-changer in relation to the scale and speed of the deployment. Not only is the vaccine massively easier to take to care homes, in particular, and GP surgeries, but the change in the dosage pattern means that we can not only deliver every single dose as it arrives in the warehouse but we do not necessarily have to book someone in for an immediate second dose. That gives our deployment programme an enormous amount of flexibility, and will lead to a great increase in our turnover: we will literally be delivering them as quickly as they can be manufactured.

Others are concerned that we are doing too much, and I will address that very quickly. In relation to projections, I have stood at this Dispatch Box and had the projections of the Government, SAGE and PHE derided by noble Lords as fearmongering. Who could possibly have believed that we would have 53,000 new infections? It is a little bit rich of noble Lords to question the work of scientists and our modelling teams in relation to their projections on today of all days. We accept advice from a very wide range of scientists; no voice is excluded. It is the role of government to synthesise advice into policy, and we do not need to smear or deride the scientists who supply that advice.

I have been through the statistics on public support on numerous occasions; I do not think I need to go through that again. There is massive public support for the measures that we have implemented. As for ignoring the Government, adherence rates are remarkably high, and I pay tribute to the public, which, although there are exceptions, by and large are incredibly committed to the regulations that are in place.

Lastly, as I have said before, it is not the Government’s policy to use two-week lockdowns as an emergency brake. These were used in Wales but not nationally, and that will not be our policy.

I agree with the sentiments of the noble Baroness, Lady Watkins—at heart, I also celebrate British liberties, but it is the virus that is not respecting liberty, not government, and we have no option but to bring in these kinds of measures to battle the virus, save lives and protect future generations.

A number of noble Lords mentioned schools, which are, without doubt, the most difficult subject at the moment. Of course it is right that we should do absolutely everything we can to keep schools open. Noble Lords who made that point enjoy my complete and utter support, but the epidemiology is very challenging. Schools have undoubtedly been the source of an enormous amount of transmission. Some of that is asymptomatic, but it is deadly nevertheless. The opening of schools has contributed to the high rate of transmission, particularly in London. It will be up to the Secretary of State for Education in the other place to make the announcement on schools, but the Government are entirely committed to trying to keep schools open for exactly the reasons cited in this Chamber, not least because it is those who come from the poorest backgrounds who undoubtedly suffer most from their closure. However, in order to make an effective regime to battle this virus we may need to make some tough decisions.

The noble Baroness, Lady Thornton, asked whether this is going to be enough. That is not for me to answer; my right honourable friend the Secretary of State for Health will be making a Statement in the other place shortly and he will address the question of any future restrictions or regulations. However, the noble Baroness is entirely right; the challenge we face this week is completely different to the one we had when we went into recess before Christmas. This new variant is of a different order; we may as well be battling a different disease. We will have to step up to that challenge in order to see ourselves through to the spring, when the vaccine will have been delivered to sufficient numbers to make a real difference. I regret that that may strike a chilling note at the end of this debate, but we have to face up to it.

Motion agreed.

Health Protection (Coronavirus, Restrictions) (All Tiers) (England) (Amendment) (No. 3) Regulations 2020

Lord Bethell Excerpts

Wednesday 30th December 2020 Lords Chamber

Moved by

[Lord Bethell]

That the Regulations laid before the House on 29 December be approved.

Instrument not yet reported by the Joint Committee on Statutory Instruments.

Motion agreed.

Covid-19: Vaccinations

Lord Bethell Excerpts

Thursday 17th December 2020 Lords Chamber

[Lord Harris of Haringey (Lab)]

I draw attention to my interests in the register and beg leave to ask the Question standing in my name.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)]

My Lords, more than 137,000 people in the UK have received the first dose of the Pfizer/BioNTech Covid-19 vaccine in the first week of the largest vaccination programme in British history, and I thank all those involved. It will take at least until spring for all high-risk groups—an estimated 25 million people in England—to be offered a Covid vaccine. We remain committed to the principle of offering everyone in Britain a vaccine.

[Lord Harris of Haringey (Lab)]

The Government have form on overpromising and underdelivering, so I am interested in the figure that the noble Lord has given. Assuming that he is going to achieve 25 million vaccinations, that means in excess of 1 million people a week being vaccinated between now and then. With 200 vaccination centres, that means something like 7,500 vaccinations per week and, if centres work 14 hours a day for seven days, that will be something like 75 per day. Does the noble Lord not think that he is in danger —again—of overpromising and—again—of fuelling the widespread belief that the crisis is over, which is leading to the behaviour that we all know is likely to fuel the number of cases in the next few weeks?

[Lord Bethell (Con)]

My Lords, the mathematics done by the noble Lord are interesting but not quite a reflection of the strategy. It is undoubtedly true that the NHS is, wisely, taking the start of the deployment with great care. This is an extremely complex vaccine to deliver, but hospital hubs, local vaccination services and vaccination centres will be rolled out around the country. The kind of ambition that the noble Lord describes—quite rightly—is exactly what we seek to deliver; we will update the House as that deployment plan rolls out.

[Baroness Warwick of Undercliffe (Lab)]

My Lords, I want to urge early access to the vaccine for the terminally ill. On Tuesday, in response to my noble friend Lady Thornton, the Minister said that there was a powerful case but any further refinements to the priority list will “create profound operational challenges”. That is not a good enough answer for my nephew, Matthew Walton, who has stage 4 brain cancer. Surely his two young children should be able to spend their remaining time together without the additional threat of an early death, which could so easily be averted by a vaccine—unlike his cancer. Will the Minister please press this powerful case?

[Lord Bethell (Con)]

The noble Baroness makes the case extremely well; I pay tribute to her personal testimony. I looked into this matter after giving my answer to the question last week. I assure the noble Baroness that those who are terminally ill are, of course, clinically vulnerable by nature. We will ensure that those who are clinically vulnerable will get the vaccine when it is clinically appropriate to do so, which I hope brings her some reassurance.

[Baroness Brinton (LD) [V]]

What provisions and logistics are in place for those not registered with GPs to receive the vaccine?

[Lord Bethell (Con)]

Those who are not registered with GPs and would like to take the vaccine need to register with GPs. We have put in place provisions to allow easier registration processes, we have updated our data arrangements and we are expecting a large number of people to seek out registration. That will be one of the benefits of the vaccination programme: clearer, better records of those in this country who are part of the NHS family.

[Lord Moynihan (Con)]

My Lords, last month, my noble friend the Minister was hoping to receive advice from the World Anti-Doping Agency for our Olympic and Paralympic sports stars preparing for the 2021 Tokyo Games on the specific point of whether MRNA vaccines were prohibited under the WADA code. I understand that the vaccines have been deemed safe and acceptable for use within the guidelines, protocols and rules of the WADA prohibited list. If this is the case, will my noble friend ask his department: to publish WADA’s detailed advice; what testing capability our national anti-doping agency—UKAD—has for synthetic messenger RNAs; and for information on when all elite sportspeople can expect to be vaccinated so that they can train and compete safely?

[Lord Bethell (Con)]

I am grateful to my noble friend for his championship of this important point. It is not necessarily the role of the department to rule on this matter, but I note that UK Anti-Doping welcomed the World Anti-Doping Agency’s publication of its view on the vaccine. We welcome that moment and I very much hope that it provides the reassurance that athletes are looking for.

[Lord Pannick (CB)]

My Lords, my mother-in-law is 84 years old. That sounds like the beginning of a bad joke but it is not funny because she has serious health concerns and is very high risk. Over the past couple of weeks, my wife has repeatedly telephoned her NHS GP practice in north-west London—I will not name it, although I am happy to tell the Minister which it is. Staff there say that they have no vaccine, no information about when they can expect to receive the vaccine, no guidance from the Department of Health and no protocols. Does this not support the concern expressed by the noble Lord, Lord Harris, that there is a real danger of the Government underperforming yet again in this context?

[Lord Bethell (Con)]

I hear the concerns of both the noble Lord and his mother very clearly but I assure him that, to date, the rollout has very much focused on the 70 hospital hubs where we are getting the protocols and practices about getting this extremely difficult vaccine into people’s arms correct before we roll out distribution to all GP services. It is not at all my expectation that every GP service in the country will have the vaccine, nor that they will necessarily be ready to deliver it this week, but that guidance has been distributed. If the noble Lord would like to send me the details, I will ensure that that GP practice is up to speed on this important matter.

[Baroness Thornton (Lab)]

My Lords, my concern is about NHS staff. They may need to deal with a third wave in the new year, they will be required to work through the Christmas period dealing with the current spike and they will be co-ordinating the vaccine—so they might be completely overstretched in January and February. Would it be a good idea to ensure that at least front-line, high-risk clinical area staff are vaccinated immediately? Does he agree that this would make sense from an operational point of view? I know from my work as a non-executive director of a London hospital that it would be a huge morale booster for the staff to whom we owe so much.

[Lord Bethell (Con)]

I take on board the noble Baroness’s points on the NHS. Its staff have been under huge pressure, which is likely to be sustained into the new year. I pay tribute to their hard work. The JCVI has looked extremely carefully at the prioritisation. The most important thing is to avoid pressure on ICUs and the threat of mortality. That has been done by prioritising age over role. I also pay tribute to the St John Ambulance service, which has done an amazing amount of work in gathering 40,000 inquiries for training on delivering the vaccine. By undergoing training, those people will relieve NHS staff of an enormous amount of the pressure that the noble Baroness rightly describes.

[Lord Scriven (LD)]

My Lords, following on from my noble friend Lady Brinton’s question, it is estimated that between hundreds of thousands and millions of people are not registered with a GP. Some have the most chaotic lifestyles, do not speak English and are not plugged into the most basic services. How will the Government make arrangements for people who are outside normal registration processes to be vaccinated?

[Lord Bethell (Con)]

The noble Lord makes the point well. He is right that there are undoubtedly communities that conventional NHS outreach has not got to; we have learned that fact during Covid. Our immediate priority is to reach the over-80s and ensure that the deployment programme works for those groups that are most at risk. We will be turning our attention to the groups that he describes, but I cannot avoid the fact that, if you are going to get a medical service, you need to be registered with a GP. That is something that some people are going to have to make part of their life.

[Lord Mann (Non-Afl)]

The registered GP services where I live are banging on the door for this vaccine at the moment. What is the latest date for a universal rollout to every primary care area in the country, making the vaccine available to those who are vulnerable?

[Lord Bethell (Con)]

I completely understand the noble Lord’s impatience to know that. I am afraid that I cannot provide him with a precise date. One reason why is because we do not know the availability of the other vaccines. As he knows, the AstraZeneca vaccine, the Moderna vaccine and three others are all in the pipeline at the moment. If they get authorisation from the MHRA, that will completely change our deployment programme. At the moment, we are putting in place contingency measures for an uplift in our deployment should any of those be authorised; that will lead to a major growth in our deployment plans.

[The Senior Deputy Speaker (Lord McFall of Alcluith)]

My Lords, the time allowed for this Question has elapsed. Oral Questions have now finished.

ONS: UK Life Expectancy

Lord Bethell Excerpts

Thursday 17th December 2020 Lords Chamber

[Lord Rooker]

To ask Her Majesty’s Government what assessment they have made of the publication by the Office for National Statistics National life tables—life expectancy in the UK: 2017 to 2019, published on 24 September.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)]

My Lords, life expectancy is at its highest level ever, but we have seen improvements stall and we expect to see adverse impacts from Covid on life expectancy data in the future. Covid has shone a light on the differences in health outcomes between communities; that is why the Government remain committed to levelling up health outcomes so that everyone can enjoy a long and healthy life.

[Lord Rooker (Lab) [V]]

My Lords, my Question has nothing to do with Covid. What are the reasons life expectancy improvements have slowed in comparison to the previous decade? The flatlining in the ONS statistics, at figure 1, is a worry because it is a trend of 10 years, and the Marmot review in February said that this had not happened since the year 1900. For women in the most deprived areas, life expectancy actually fell between 2010 and 2018, so why has there been no national health inequality strategy since 2010? Why has that disappeared off the face of our policy-making? When does the Minister expect the flatline to go back up again?

[Lord Bethell (Con)]

My Lords, the noble Lord is entirely right that this stalling of the life expectancy curve is extremely worrying, and he is right to emphasise the disappointing results in deprived communities, where, as he says, we are going backwards instead of forwards. Covid has shown how that has a huge impact on the resilience of the nation’s public health. The Government are committed to this agenda—we published a prevention Green Paper and we are committed to building a strategy out of that Green Paper, and since then we have done work on better health, on obesity and on other areas of life expectancy—but I agree with him that more can and should be done.

[Lord Davies of Brixton (Lab)]

My Lords, it is clear that there has been a downturn in the rate of mortality improvement since 2010, and the evidence is that the impact of these negative trends has been greater among more deprived groups, with some suffering an actual decline in their expected lifespan. Does the Minister accept that a significant reason for this has been the imposition of austerity policies since 2010 under successive Conservative Governments?

[Lord Bethell (Con)]

No, I do not.

[The Lord Bishop of Durham [V]]

Given the ONS recent findings that the lowest regional life expectancy for both male and female children at birth in 2017-19 was observed in my area of the north-east of England, when will Her Majesty’s Government commit to a full- blown strategy to eliminate the obstacles disproportionately facing children in poverty here in the north-east?

[Lord Bethell (Con)]

The right reverend Prelate is right to emphasise some of the disappointing figures around children, and the north-east is one area where the challenge is greatest. But I remind him that we have strategies for healthy behaviours in school, we are committing a huge amount of funding for more physical activity in schools, and we think that this will have a major impact on both the fitness and healthy outcomes of children. That kind of project will make a big impact.

[Lord Kirkhope of Harrogate (Con) [V]]

My Lords, can my noble friend give any real explanation as to why the UK is so low down on the OECD figures for average annual increases in life expectancy at birth? On the ONS tables, England is 18th out of 21 countries, with Scotland and Wales faring even worse. Is there a particular reason he can think of—could it be methodology or social habits? Has he any further explanation of the comparative situation here?

[Lord Bethell (Con)]

My Lords, I cannot give an answer in the round and explain every element, but we have to face up as a nation to the fact that some of our habits are unhealthy. In some communities smoking rates are extremely high, and the difference between different communities is profound—1.6% in west London, compared to 25.7% in Blackpool. Our obesity, BMI and consumption of high-calorie food is just too high. This is not the sole explanation, but as a nation we have to face up to some of our behaviours.

[Lord Rennard (LD)]

My Lords, half the considerable difference in life expectancy between the richest and poorest in our country is entirely accounted for by smoking. At present, the Government are spending considerable amounts of money on advertising campaigns which tell people how to keep safe during the Covid pandemic. In the future, will the Government reinstate advertising aimed at promoting smoking cessation, to meet their own target of making Britain a smoke-free country and helping to improve the health and life expectancy of the poorest in our society?

[Lord Bethell (Con)]

The noble Lord makes his point extremely well: smoking rates in this country are far too high. The huge amount of Covid advertising at the moment has squeezed out a lot of our public health messages, and I reassure him that we will return to them—including the smoking campaign—when normal business resumes.

[Baroness Redfern (Con) [V]]

My Lords, there have been life expectancy improvements in the UK, which I welcome. My concern regards paediatric obesity, which brings associated increased risks of morbidity, disability and premature mortality in adulthood. The Government have set a national ambition to halve childhood obesity rates by 2030. As they have taken a strong lead with the soft drinks industry levy, what proposals are being looked at to extend its mandatory approach beyond soft drinks to wider product ranges?

[Lord Bethell (Con)]

The noble Baroness is entirely right: 15% of children aged two to 15 are obese. That is a shocking figure, and extremely disappointing. We have already done a lot to bring in the taxes on sugary drinks, and we are ploughing the money from them into sport in schools. But she is right that the taxes on sugary drinks provide an interesting template, which could be used in other areas where industry fails to step up to its responsibility and to reduce the harm of fatty or other destructive foods.

[Lord Patel (CB) [V]]

My Lords, the Science and Technology Committee, which I have the privilege to chair, will publish a report in January on ageing, science, technology and healthy living, which noble Lords will find an interesting read. The Government have set themselves a grand challenge, with a target of increasing healthy life by five years by 2035. In light of the ONS report and the effects of the pandemic, what increased barriers do the Government think that they face to achieving that—or can it be achieved at all? If the Minister wishes to give a Written Answer, with a copy in the Library, I would be content with that.

[Lord Bethell (Con)]

The noble Lord makes his point extremely delicately and politely, but he is entirely right. We have a commitment for five extra healthy years by 2035, and the combination of the Marmot review, the ONS figures and Covid make that seem an extremely daunting challenge indeed. I am not sure if I have the complete answer standing at the Dispatch Box right now. I would be glad to write to him and explain how we will undertake the Green Paper on prevention, the response to which will be published next year, as an opportunity to outline the kind of strategy he calls for.

[Baroness Thornton (Lab)]

The Minister’s response to my noble friend Lord Davies of Brixton was an abrupt one, which kind of suggested that it was an accident that we are where we are with life expectancy and that the Government’s policies have no impact on that. My question actually follows very neatly from that of the noble Lord, Lord Patel. Do the Government intend to establish life expectancy and well-being as a strategic marker and measure for the whole nation’s well-being and welfare in all Acts? How will that feed into reforms for the NHS?

[Lord Bethell (Con)]

My Lords, I think that healthy living and life expectancy is a strategic marker. We are naturally focused on it and, in particular, the disparities between communities, which have been alluded to by a number of noble Lords. The huge gap between life expectancy in Blackpool and west London is extremely disturbing, and something that the Government are highly focused on. These are complex issues. They involve government policy—as the noble Baroness quite rightly points out—but also personal behaviours, and it will very much form part of the NHS plan going forward and the rebooting of the NHS in a post-Covid world.

[The Senior Deputy Speaker (Lord McFall of Alcluith)]

My Lords, the time allowed for this Question has elapsed.

Covid-19 Update

Lord Bethell Excerpts

Tuesday 15th December 2020 Lords Chamber

[Baroness Jolly (LD) [V]]

I support the points made by the noble Baroness, Lady Thornton, on lockdown; she and I have repeated them regularly in these debates, and yet there is no change. My points will be around vaccines, acute hospitals and their staffing, and Christmas. I thank the Minister for repeating the Statement and join him in welcoming the news about vaccines. Anyone in need of a real feelgood story should watch last night’s “Panorama” programme about the development of the Oxford team’s AstraZeneca vaccine.

How confident is the Minister of 100% vaccine coverage, for those that are entitled, by Easter 2021? This is a lot of people, and we are not certain of all vaccines being available by that time. Could he explain to the House what determines who receives the AstraZeneca vaccine and who the Pfizer—or indeed any other vaccine that may come along? Is he confident that the new vaccines will be effective against the new variant that is emerging?

Can the Minister give us a statement about acute hospitals in tier 3 areas? At the moment, it looks as though the rise in cases in the London area and the south-east is almost matched by the rise in hospital admissions—they are just a percentage point apart. Are the Government confident in London’s hospital capacity? We know that, in some areas, there are Nightingale hospitals; is the NHS intending to bring them into use if necessary? Are there the clinical and other staff to run them?

For many of us, an in-person Christmas may not be possible. We need to look at the impacts that Thanksgiving had on the US Covid-19 figures and assess our risk. Many of my contemporaries have decided not to travel to celebrate with friends and family, and our children have told us that this is what we are going to do as well, so it looks as if many will be resorting to whatever is their favourite conferencing software to catch up with family.

Finally, will the Minister outline the Government’s communication strategy for Christmas? Clear messaging is imperative but many of the public who have been interviewed are unclear. Will ads be used in newspapers, broadcasts and online social media? Christmas is 10 days away, and people would appreciate a clear steer from the Government. This needs urgent and professional communications attention.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con) [V]]

My Lords, I am extremely grateful for the clear and thoughtful questioning from the noble Baronesses, Lady Thornton and Lady Jolly. Both of them are right: we are seeing a sharp rise in south Wales, London and parts of the east and south-east of England, which is making us rethink some of our approach to Christmas. We have seen a sharp rise in the virus across London, Kent, parts of Essex and Hertfordshire, and reports of a new variant. We saw the evidence of this starting in the 15 to 19 year-old age group and we have taken swift and decisive action but, unfortunately, more may be necessary. We know that this rise will be mirrored in hospital admissions, and it takes only a few doubling times to put pressure on the NHS. The noble Baroness, Lady Jolly, is absolutely right to question whether we have the resources in place to see such doubling take place over time. This is a trend we are seeing all over Europe, in countries such as Sweden, where nearly all the intensive care in Stockholm is currently in use, and even in Germany, where tougher new restrictions were announced over the weekend.

It is entirely natural that we look very closely at the Christmas relaxation, but I am not in a position to share any update on that this evening. The noble Baroness, Lady Thornton, asked: what is the Secretary of State’s plan to keep us safe? We have plans, and I will be glad to share them with noble Lords. However, may I just say a word about personal responsibility? The noble Baroness, Lady Thornton, put it well: it is up to each and every one of us to decide whether we will take a minimalist or maximalist interpretation of the rules. At the end of the day, it is a personal decision on what kind of risk approach one will take to Christmas. The SAGE advice has been published and it is clear. It does not make very comfortable reading for those of us with elderly relations who have been looking forward to seeing us, but it clearly states that we should be looking to spend time at Christmas with as few people as possible for as short a time as possible and, wherever possible, outside instead of inside. I am afraid to say that that will be what a responsible Christmas looks like for everyone. It is not something that the Secretary of State can ordain; it is, unfortunately, what the spread of the virus requires.

I acknowledge—the noble Baroness, Lady Thornton alluded to this—that the tier 3 regimes, particularly in the north of England, have had a profound impact. The behaviours of people in the tier 3 areas have been considerably amended, and that has seen a sharp reduction in the infection rates in those areas. It demonstrates that restraint works, and I take a moment to applaud all those who have played a role in that achievement.

On the vaccine, I will be very happy to provide an update on the special cases that the noble Baronesses alluded to. Both the case for unpaid carers and the case for the terminally ill are powerful, and we are listening carefully to them as they are made. However, the JCVI has put in its priority decision and that is what we are working to at the moment. Any further complications or refinements to that create profound operational challenges, but we are listening very sensitively to the case being made for the special cases.

I share the tribute of the noble Baroness, Lady Jolly, to the AstraZeneca team. The “Panorama” programme last night was a tonic for the soul during these difficult times, and I would recommend it to everyone.

As to the new variant to which the noble Baroness, Lady Jolly, alluded, the preliminary scientific judgment is that it does not at the moment show any evidence that it will escape either the vaccine or any other therapeutics that are targeted at Covid. That is always the natural concern in these circumstances; we are studying it very carefully indeed and will, of course, update the House if any changes do emerge. However, the new variant, which has been correlated with higher levels of transmissibility in Kent, does remind us that the threat of Covid is undiminished and we must remain committed to the restrictions in place to contain this horrible virus.

[The Deputy Speaker (Baroness Morris of Bolton) (Con)]

My Lords, we now come to the 30 minutes allocated for Back-Bench questions.

[Lord Patel (CB) [V]]

My Lords, we know that all viruses evolve and, while we do not yet know whether the genomic variant identified is more infectious, we do know that the transmission rate of the virus is rising exponentially. By the way, the Minister just said that the new variant correlates with increases in infection; the word “correlates” suggests cause and effect that has not yet been proven. Can the Minister tell us what scientific matrix the Government will use over the next week to make the political decision on whether to ease or otherwise the current restrictions, going forward to Christmas and beyond?

[Lord Bethell (Con) [V]]

My Lords, I am extremely grateful to the noble Lord, Lord Patel, for his description of affairs, which, as ever, is as thoughtful as we would hope. However, I clarify and disagree with him in that correlation and causation are not the same things. I chose my words extremely carefully: there is a correlation with higher transmissibility, but there is no evidence that this is caused by the variant; I want to be crystal clear about that. I pay tribute to colleagues at the Sanger and at COG, the genomics collective that is doing the work on tracking down the science of the new variant. Their insight is profound and they will be playing into the decisions about whether any judgment on the variant should play a role in the decisions about any future restrictions.

[Lord Hayward (Con)]

My Lords, does my noble friend the Minister accept what I deem to be the position in relation to the younger generation: that they are suffering from lockdown fatigue and are not responding to government messages? I suggest that, rather than having government Ministers and some scientists conveying the message of the importance of acting responsibly, they consider along with Jonathan Van-Tam somebody like Marcus Rashford, Rio Ferdinand or Harry Kane to convey the message that we are failing to get across? In association with that and the comments that have been made elsewhere, can the Minister tell us whether he has any information, in light of the FDA’s announcement, as to whether the Moderna vaccine will be recognised in this country in the near future?

[Lord Bethell (Con) [V]]

My Lords, I feel the point that my noble friend makes extremely personally. I am currently isolating with a 14 year-old; like many 14 year-olds, he and his friends never demonstrate any symptoms of Covid whatever and yet it would seem that they are carriers and vectors of the infection. The recent explosion in transmission in London and the south-east was led and probably caused by the 14 to 18-year-old age group, even though almost all of them are completely asymptomatic. We have worked with celebrities and opinion leaders in the youth groups to try to get this message across, but I point my noble friend to the announcement today of a very large increase in the use of asymptomatic testing in schools in the new year, as an indication of our commitment to ensuring that transmission among asymptomatic young people is contained.

[Lord Winston (Lab) [V]]

I thank the noble Lord for repeating the Statement. I concur with what the noble Baroness, Lady Thornton, said from the Front Bench. We know from the history of plagues that they occur through travel. This happened in the 1340s and again in the 1660s with the plague of London. Now we are seeing people travelling to London, which is a massive hub of travel; they come to the airport, they do not leave a phone number or address—they are not required to do so—and tests at the airport are voluntary. Many people go missing and are not followed up by a proper track. When they get tested, they pay for it, so it is entirely voluntary. Does the noble Lord feel that these arrangements are sufficient, given that so many people travel to London and that there is a risk of this plague continuing just as they have done historically?

[Lord Bethell (Con) [V]]

I am grateful for the noble Lord’s insight. He is right that travel is the friend of the virus. Many of the growths in transmission have been associated with it; one thinks of the ski resort holidays at the beginning, the spring break migrations in America and other examples. I reassure him that, while he is right to question the arrangements around our airports and transport hubs, we have brought in a much more strenuous test to release programme which is much more realistic than the previous isolation programme. The procedures around the passenger location ports have been tightened up and the enforcement and tracking arrangements for passengers have been supplemented. There is now a very strong body of evidence to suggest that passengers are abiding by the testing programme. As he may know, private tests were launched yesterday, and their uptake has been incredibly impressive.

[Baroness Hollins (CB) [V]]

My Lords, 200,000 people are on their GP’s learning disability register and get the flu jab on the same terms as over-65s, but only one in 10 of this group has been prioritised for vaccination. My research 25 years ago found that these people were 58 times more likely to die before the age of 50 in ordinary times, and PHE research found a death rate 30 times higher for 18 to 34 year-olds with learning disabilities than for others of the same age during the first wave. To require them to wait until their chronological age group is eligible seems discriminatory. Will the Minister commit to look at this again?

[Lord Bethell (Con) [V]]

I completely acknowledge the correlation between mortality and learning difficulties that the noble Baroness alludes to. PHE has looked at this in respect of Covid very closely. That evidence played into the JCVI prioritisation process; it landed on age as the main determinant for that process but continues to review this based on evidence. The noble Baroness makes a good case, but I reassure her that the JCVI has looked at all this evidence very closely.

[Lord Robathan (Con)]

My Lords, during all these restrictions and over the lockdown we had for one month, which ended on 2 December, we have been told that the Government are following the science—the “unstoppable force of science”, to quote the Secretary of State in yesterday’s Statement. However, in late September SAGE recommended circuit breakers of two to three weeks, which Wales imposed for 17 days until 9 November; it now has coronavirus rates that are nearly three times those of England. What confidence does the Minister have in the scientific advice he is given?

[Lord Bethell (Con) [V]]

My Lords, the restrictions in England have never been based on a two-week circuit breaker. It was not a policy that the DHSC supported.

[The Deputy Speaker (Baroness Watkins of Tavistock) (CB)]

The noble Baroness, Lady Blower, has withdrawn, so I call the noble and gallant Lord, Lord Craig of Radley.

[Lord Craig of Radley (CB) [V]]

My Lords, the Statement refers to a new variant of the virus. Is this the only variant, or are others being found overseas? Porton Down is working to discover whether the current vaccines will remain effective. When does it hope to report? I declare an interest: I was vaccinated in the Fakenham medical centre in Norfolk this morning—a very efficient and reassuring experience—which had 365 planned for today.

[Lord Bethell (Con) [V]]

I massively congratulate the noble and gallant Lord on his vaccination this morning. I am extremely proud of that moment and glad that he has taken a step towards safety. It is a fantastic piece of news, which we should all celebrate.

On the noble and gallant Lord’s question on the variant, there are dozens—possibly hundreds—of variants, some of which are minimal and insignificant. The one that has been thrown up in Kent is being singled out only because it correlates with an increase in transmissions in Kent. It is not certain whether this is because of the variant or because of behaviours in Kent, but naturally we are worried about it. I am not a biologist, but I am assured by the biologists that the new variant does not seem to show any attributes that would mean that it could escape the vaccine. Naturally, we are looking at it very closely and hope to have an answer to his question shortly.

[Lord Randall of Uxbridge (Con) [V]]

My Lords, the Government are between a rock and a hard place with regard to the Christmas arrangements. If it is decided that circumstances now dictate a change, does my noble friend agree that it is imperative that the public are given as much notice as possible of any changes?

--- Later in debate ---

[Lord Bethell (Con) [V]]

My Lords, we always seek to give the public as much notice as possible. But I accept that one of the most frustrating aspects of this pandemic has been that the virus does not behave as predicted, and that the response to restrictions and policies by the public has not always turned out exactly as we planned. It is therefore sometimes true that our policies need to change at short notice. This is incredibly challenging for the public—I do not duck that point in any way—and I am extremely grateful to the public for their forbearance under the circumstances.

[Lord Mackenzie of Framwellgate (Non-Afl) [V]]

My Lords, I can fully understand the necessity for additional measures announced by the Health Secretary in another place yesterday in light of the statistics. It is not just Covid deaths likely to increase but, of course, the deaths from diagnostics not being carried out on potential cancer and stroke patients—not to mention the pain and misery being inflicted on patients who have to postpone elective life-altering surgery. Is there not now a powerful case for the Government to consider reversing the superspreader travel festivities bonanza during the five days of Christmas which, as night follows day, will inevitably lead to more infections, hospital admissions and deaths, as has happened in America following Thanksgiving?

Finally, having heard the Minister’s considered responses this evening, am I right to feel a little more optimistic?

[Lord Bethell (Con) [V]]

My Lords, the noble Lord, Lord Mackenzie, makes a powerful case. There is undoubtedly a dilemma about what we should do in the approach to Christmas. The country does deserve a break, because it has done so much this year to contain the virus, and yet the consequences of too much social mingling are harsh, as he rightly describes. I reassure him that we have done a huge amount to restart elective surgery and other diagnostics and to get the NHS working as hard as we possibly can. It is our objective to ensure that the non-Covid death rate is not affected by the Covid response.

[Lord Campbell-Savours (Lab) [V]]

My Lords, can I return to the issue of masks, which I have been pushing since February? With London in lockdown, a new variant and the prospect of an explosion in transmission in the new year, why not, in this rapidly developing crisis, adopt a vigorous belt-and-braces approach, follow worldwide mandatory practice and require mask wearing in all public places outside the home? Why not ban the use of valved masks, apart from in clinical settings? They protect only the wearer. Now is the time for really tough decisions; there is a big crisis that confronts us.

[Lord Bethell (Con) [V]]

My Lords, I pay tribute to the campaign and advocacy by the noble Lord, Lord Campbell-Savours, on masks. He has moved the needle on this subject. I would argue, perhaps, that there is a huge amount of mask-wearing, particularly in public places; certainly in shops, on transport and even in the House of Lords, mask-wearing has become mandatory. So, he has already come a long way. We continue to review additional options in this area. His point on valve masks is extremely well made and is one that I have made to the relevant officials.

[Baroness Finlay of Llandaff (CB) [V]]

My Lords, I declare that I chair the National Mental Capacity Forum. I ask the Minister to express thanks to staff in his department as they continue to work with us and the Ministry of Justice to run a rapid-response webinar on Friday, requested from primary care leads yesterday, following their pilot, to support primary care as vaccination is rolled out to care homes, where many residents have seriously impaired capacity. We aim to disseminate the latest guidance and ensure appropriate information to support understanding for consent to vaccination, including easy-read and pictorial versions of information.

[Lord Bethell (Con) [V]]

I am enormously grateful for the work that the noble Baroness, Lady Finlay, and the National Mental Capacity Forum have done during the pandemic. The issue of mental capacity and consent has been addressed in official guidance that the NHS and others have issued to medical professionals who will administer the Covid vaccine in care homes. I understand that officials at the DHSE and the MoJ are supporting the forum with the webinar planned for this Friday, and I am absolutely delighted to reaffirm the Government’s support for the forum’s work on these important areas.

[Baroness Verma (Con)]

Will my noble friend do a communications strategy or campaign to debunk the idea that the vaccines have animal content? There are messages going around on social media that would stop people from minority communities, in particular, from having the vaccine if it did have animal content.

[Lord Bethell (Con) [V]]

I thank my noble friend for providing this opportunity to scotch that unhelpful rumour. I confirm that there are absolutely no animal components in the vaccine. That point has been endorsed by the British Islamic Medical Association, members of which issued a fatwa earlier this year confirming that the vaccine was halal. My noble friend is right that there are stories on social media that are extremely distracting. We engage with sympathy with those who are concerned about the vaccine, but these stories are completely wrong, and I would like to put them to bed.

[Lord Hunt of Kings Heath (Lab) [V]]

May I continue on the theme of vaccines? Has the Minister seen the very recent survey by King’s College and Ipsos MORI, which found that 46% of all 16 to 34 year-olds say that they have seen or heard messages discouraging the public from getting the vaccine? Alarmingly, 27% of them believe that the real purpose of a mass vaccine programme against coronavirus is to track and control the population. Social media is playing such an important role in vaccine disinformation. Is the Minister really satisfied that all is being done to combat it?

[Lord Bethell (Con) [V]]

My Lords, the noble Lord, Lord Hunt, is right to be concerned. Some of the data we have on public attitudes is of extreme concern and the statistics he has referred to show exactly why we have focused on this area as much as we have. We have worked extremely closely with social media platforms to try to minimise the availability of this material, and we have a large communications programme to engage with those concerned about taking the vaccine. I reassure him that our experience to date has been that when those who are considering taking the vaccine reach the moment of decision, their confidence increases, and I am hopeful that that will continue.

[Baroness Stuart of Edgbaston (Non-Afl)]

My Lords, in the Statement made in the other place, reference was made to notification to the World Health Organization about the new variant. The Statement went on to say:

“Public Health England is working hard to continue its expert analysis at Porton Down.”—[Official Report, Commons, 14/12/20; col. 23.]


I invite the Minister to make it absolutely clear that the work done at Porton Down is on behalf of the whole United Kingdom, not only Public Health England, and that any of the vaccinations which have been procured are procured on behalf of the whole United Kingdom. He may also want to say how the vaccines are to be distributed.

[Lord Bethell (Con) [V]]

The noble Baroness is entirely right. The vaccine is a great success story for the union and for the United Kingdom. We have had a four-nation approach and the distribution of the vaccine shows the union at its best. She is right to say that the work done at Porton Down is on behalf of all the nations of the United Kingdom and that the communication to the WHO was on behalf of the whole country. That communication demonstrates that our approach to the vaccine is to put transparency first and that we have moved extremely quickly to share this insight with our colleagues overseas.

[Viscount Waverley (CB) [V]]

My Lords, I am reliably informed that only two of the 14 passengers in a carriage on the 5.48 am Southeastern train from Gravesend to the London terminus this morning were wearing masks, so clearly the message is not getting through. Adding to the words that the Minister offered to the remarks of the noble Lord, Lord Winston, on the challenges that have appeared this morning of the long- awaited test release scheme, I ask: why not resolve this in part by passengers obtaining a test evidencing a negative result within 72 hours of travel into the UK? Further, if they have received a vaccination abroad or a negative test result abroad, will official confirmation from an appropriate authority from abroad be acceptable to the United Kingdom?

[Lord Bethell (Con) [V]]

If I have heard the question correctly, that is exactly how the test release scheme works. Travellers are invited to sign the appropriate forms and after some days they can be released from isolation early by taking tests. That scheme has been signed off by the Chief Medical Officer and data from the test is transmitted to Public Health England. We currently have a UK-only testing regime and we do not take tests from overseas, but we are keeping the scheme under review.

[Lord Balfe (Con)]

My Lords, it appears that it is among younger people where the spread is now concentrated. What is the severity of the infection? It has been put to me that it is not that severe and that, indeed, many younger people are saying that they have to learn to live with it. I do not think that things are helped by the harsh rhetoric of “4,000 deaths a day” and so on. It just goes over people’s heads. They are saying, “This is not believable. They are going on about it, but it doesn’t matter.” Instead of using punitive terms, could the Minister go for more of a nudge theory, as put forward by David Cameron, and try to persuade people that it is in the interests of everyone to do certain things, rather than terrify them all the time—because that is not working?

[Lord Bethell (Con) [V]]

My noble friend Lord Balfe is entirely right to say that the symptoms in young people are zero in many cases. There are issues of both saliency and believability among many young people who think that this is a disease that simply does not touch their lives. It is understandable that they may think it implausible that they could be carrying the disease. However, the statistics are crystal clear. When looking at the heat maps, you can see easily how infections grow among the young and then graduate through the demographics until they hit older people, and then hospital admissions rise. I am extremely sympathetic to young people and why they find this idea a challenge to believe in, but we have to hit home with this message—otherwise, we will not be able to contain the disease.

[Baroness Bennett of Manor Castle (GP)]

My Lords, my question follows that asked earlier by the noble Lord, Lord Young of Cookham, to the noble Baroness, Lady Stedman-Scott. It referred to how some local authorities have run out of funds to give the £500 payment for people to self-isolate, when they would not otherwise be able to financially. In response, the noble Baroness said that there is only a fixed envelope of money, suggesting that no more would be provided to those local authorities. As Health Minister, would the noble Lord agree with me that, whatever tier people are living in, they have to be able to self-isolate and feed themselves, pay their rent, et cetera? Do people not need that £500 in every part of the country, without there being a postcode lottery?

[Lord Bethell (Con) [V]]

My Lords, the noble Baroness is entirely right: the whole purpose of the isolation payments and the idea behind them is the recognition that people who are being asked to self-isolate, particularly if they come from a low-income household, to which the isolation payment is targeted, need financial support to fulfil their civic obligations. That is why we put the scheme in place. It is true that it has been tremendously successful in some areas. We continue to review whether that fund needs to be topped up.

[The Deputy Speaker (Baroness Watkins of Tavistock) (CB)]

The noble Lord, Lord Rooker, and the noble Baroness, Lady Fox of Buckley, have withdrawn, so I call the noble Lord, Lord Singh of Wimbledon.

[Lord Singh of Wimbledon (CB) [V]]

My Lords, the Statement rightly emphasises the need for swift and decisive action to control the deadly virus, which is increasingly affecting schoolchildren. Yet, when a few schools in London planned to close a few days before the end of term but to continue with internet classes, they were threatened with legal action. Does the Minister agree that, while children’s education is important, their health and that of their parents and grandparents should also be considered before rushing to legal threats?

[Lord Bethell (Con) [V]]

The noble Lord makes his point well, but I respectfully disagree. One of the great challenges from closing schools is that young people then socialise and spread the disease much further and wider than they would if they stayed at school. This has been demonstrated time and again around the world. Also, to keep our hospitals open and our businesses and education systems going, and to stop deprivation from accelerating, it is desperately important to keep schools open. That is why, today, we announced the rollout of a much greater and enhanced asymptomatic testing regime for schools, in the new year, which will see bubble and teacher testing, so that schools can remain open.

[Baroness Uddin (Non-Afl) [V]]

My Lords, in the light of the British Medical Journal’s formal joint letter with the Health Service Journal, I hope that the Minister will reconsider the Christmas relaxation of the rules. The point I wish to make really echoes those of my noble friends Lady Verma and Lord Hunt. It is about the scepticism around medicine within some sections of the communities—in particular within Bangladeshi communities, where disproportionate numbers of deaths and infections have occurred. In the light of many noble Lords raising questions about communication issues, will the Minister urgently meet me and some of the local specialist media to consider reviewing the messaging that targets some of these communities?

[Lord Bethell (Con) [V]]

I completely accept the point made by the noble Baroness. It is incredibly frustrating that the exact communities which have often seen some of the highest mortality rates are also those which are sceptical about the vaccine. This is one of our biggest challenges; it has been for months and will continue to be so. I pay tribute to colleagues at the Department of Health and the Cabinet Office who have done a huge amount in working with specialist media—radio, magazines and online forums—to target exactly these communities. They have used advertising and direct engagement with the presenters to put the message across, often in local languages, and this has proved increasingly effective.

[The Deputy Speaker (Baroness Watkins of Tavistock) (CB)]

My Lords, all speakers have been called.

Care Quality Commission Report

Lord Bethell Excerpts

Tuesday 15th December 2020 Lords Chamber

[Baroness Bull]

To ask Her Majesty’s Government what steps they are taking in response to the report by the Care Quality Commission Out of Sight—Who Cares?, published on 22 October.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con) [V]]

My Lords, the Government are clear that in-patient care should be high quality, therapeutic and for the shortest time possible, and that any kind of restraint should be used only as a last resort and in line with strict protocols. That is why the evidence in the CQC report of poor care and excessive use of restrictive practices is so unacceptable. Our response to the report from the Joint Committee on Human Rights in October outlines many of the measures that we are already taking. We will respond formally to the specific recommendations in the CQC’s report at the earliest opportunity.

[Baroness Bull (CB)]

My Lords, this report details an horrific culture of restraint, seclusion and segregation in the care of people with learning disabilities and autism. NHS data seems to show around 3,400 in in-patient care, some in isolation for 13 years, with no meaningful activity, outdoor space, natural light, furniture or belongings—their food served through hatches and their only human contact via intercoms and screens. Does the Minister agree that, while that number is unacceptably high, it is low enough that the development of pathways individualised to support community living should be possible? The costs might be high, but the cost of hospitalisation is higher. When will government deliver those long-promised solutions and end these abuses of human rights and human dignity?

[Lord Bethell (Con) [V]]

I am not sure that I completely recognise the numbers given by the noble Baroness. In August, there were 365 instances of seclusion and 10 instances of segregation of those with autism and learning difficulties, but I would be glad to correspond with the noble Baroness to clarify those things.

I reassure the noble Baroness that the progress that we are making to create the pathways to which she rightly alludes is very much the focus of the department. Earlier this morning, the Minister for Social Care chaired the first Building the Right Support delivery board, in which she brought together representatives of the NHS, LGA, ADS, DfE and MHCLG to make progress on exactly what the noble Baroness is talking about. I reassure her that funds of £74 million have been put in place to help those with autism and learning difficulties who are being discharged into the community.

[Baroness Wheeler (Lab)]

My Lords, the 66 case studies across hospitals and community settings in this very shocking report were of extremely vulnerable people who have all been badly let down by the health and social care system. Most depressing of all is that the actions promised after Winterbourne View and similar appalling situations in the past, which we hoped would lead to major changes in treatment and understanding in the care and support of autistic people and those with learning difficulties, have just not happened. Once again, there is a litany from the patients themselves, and from their families and carers, saying that, if they had received help and support earlier, or when in crisis, they may not have needed hospital care. What are the Government doing to ensure that the right community support is in place for people with autism or learning difficulties in every local area?

[Lord Bethell (Con) [V]]

I completely endorse the noble Baroness’s observations. She is entirely right that the 66 case studies in the report make very harrowing reading. That is why the report was commissioned in the first place, as an acknowledgment that the current state of affairs is not acceptable and needs to improve. Overall, £4.5 billion is going to primary care and community health services, and that is additional money to be committed by 2023-24. It is part of the Government’s overall commitment in this area, and we look forward to publishing a White Paper on mental health shortly.

[Baroness Fox of Buckley (Non-Afl)]

I thank the noble Baroness, Lady Bull, for tabling this Question. The Care Quality Commission report is deeply shocking reading—the utter cruelty of using seclusion and segregation in care settings for people who cannot advocate for themselves. I note that the report recommends that families and advocates are involved in the development of care plans, and I fully agree with that.

Would the Minister comment on the unintentional consequences of Covid regulations in care homes, which means that there has been a huge expansion of the numbers of those who are secluded and segregated who cannot advocate for themselves? For example, there are those with dementia who have been locked away, deprived of contact with their advocates and loved ones and, equally, treated with undignified and inhumane measures. Will he look at the harrowing examples detailed by the Rights for Residents campaign, which will show him that it is not just a small number now but many more, sadly, as an unintentional consequence of government policy?

[Lord Bethell (Con) [V]]

My Lords, I would be grateful to hear from the Rights for Residents campaign, which sounds like an important and valuable contribution. I reassure the noble Baroness that the numbers of those who have undergone restrictive practices who have autism or learning difficulties do not appear to have risen during the pandemic. That is not to say that the current numbers are acceptable.

[Baroness Browning (Con) [V]]

My Lords, I refer to my interests in the register. My noble friend has not mentioned—and I would like to remind him of it—that in 2009 Parliament passed the Autism Act. It is the only medically diagnosed condition, apart from mental health, considered important enough to have its own Act of Parliament. Many of the issues raised in the CQC report to do with diagnosis and failure to intervene at an early stage with appropriate and timely interventions are covered in the Autism Act. Will he ask his department to look again at that Act, which is subject to ministerial guidance, and make sure that not only is it implemented but there is sufficient funding for that Act to be put into practice?

[Lord Bethell (Con) [V]]

I am very grateful for the reminder from the noble Baroness, and I would be glad to take her recommendation back to the department and write to her on whether there are any measures that we need to put in place to ensure that we are fulfilling our commitments under the Autism Act. It was an important Act, and I suspect that we are well within the measures that it has enacted.

[The Lord Speaker (Lord Fowler)]

Can we speed up a little, please? I call the noble Baroness, Lady Jolly.

[Baroness Jolly (LD) [V]]

My Lords, the noble Baroness, Lady Wheeler, is right to flag that this is not the first time that we have heard this catalogue of appalling treatment. The shame is that in some places local authorities and the NHS use a one-size-fits-all approach to commissioning services. We have to put the individual in care at the centre and treat them and their needs. When did a Minister last issue commissioning guidance to local authorities and the NHS in this matter, as the partners that have to commission the process? What family involvement is recommended in those conversations?

[Lord Bethell (Con) [V]]

I cannot go into details of commissioning guidance in this short Question, but I reassure the noble Baroness that, when it comes to family involvement, new guidance has been issued in response to the Joint Committee on Human Rights, which puts family involvement in any seclusion or restraint decision. That is an immediate development since the report in October.

--- Later in debate ---

[The Lord Speaker (Lord Fowler)]

Did the Minister hear that in his babysitting duties?

[Lord Bethell (Con) [V]]

My Lords, my noble friend makes an extremely important point. The role of families and communities in the social care provided to those with autism and learning difficulties is extremely important and will be at the centre of every recommendation that we make in response to this report.

[Baroness Finlay of Llandaff (CB) [V]]

I declare my role as chair of the National Mental Capacity Forum. Are the Government considering the separation of learning disabilities from within the Mental Health Act to drive training in early crisis recognition and de-escalation in the community, learn from good practice and pilot alternative ways of providing places of safety in a crisis? The underlying social problems need social care solutions and are not always appropriate for, or amenable to, medical intervention.

[Lord Bethell (Con) [V]]

The noble Baroness makes her point extremely well. These are exactly the kinds of questions that have been considered by Sir Simon Wessely’s review of the Act. As I said earlier, we are looking forward to publishing a White Paper on the Mental Health Act 1983 shortly, and those are exactly the kinds of issues that it will seek to address.

[Lord Touhig (Lab) [V]]

My Lords, I refer the House to my interests in the register. As vice-chairman of the All-Party Parliamentary Group on Autism, I know all too well the devastating impact this undignified and inhumane so-called care has had on many autistic people. A new autism strategy is crucial, setting out how the Government will ensure that autistic people receive the right support and social services care in the first place, so that they do not end up in these hospitals. Can the Minister assure the House that the autism strategy will address this and the services supporting it receive the funding they need so that autistic people can have the quality of life we all enjoy and take for granted?

[Lord Bethell (Con) [V]]

I completely acknowledge the noble Lord’s championship in this area. He is right that autism is a distinct condition that should not necessarily be treated in a clinical surrounding, and I pay tribute to those in social care and community care who provide more thoughtful, considerate and sympathetic care environments for those with autism. I share his aspiration that those with autism should be cared for in a productive way that gives them fulfilled lives. He is entirely right that we need to continually refine our strategies to ensure this ambition.

Ockenden Review

Lord Bethell Excerpts

Monday 14th December 2020 Lords Chamber

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con) [V]]

My Lords, I start by echoing the very thoughtful words of the noble Baroness, Lady Thornton, and the noble Lord, Lord Scriven, in their reflections on this harrowing report. It does make desperately awful reading. Any noble Lord who took the time to read the report would surely be enormously moved, not just by the story of the cultural and practical problems at the Shrewsbury and Telford Hospital NHS Trust, but also by the personal testimony of Rhiannon Davies—who fought an 11-year campaign after the death of her daughter, Kate—and of Kayleigh Griffiths. They both campaigned stubbornly and with great determination after the deaths of their daughters. They have done a phenomenal thing in bringing this situation to light, and we owe them our compassion and our thanks for their hard work and determination.

We also owe great thanks to Donna Ockenden, who has done a memorable job in terms of this report. It is a massive enterprise that is the result of a huge human investment of time and emotional commitment by Donna and her staff. The report itself is not only huge in scale but great in the humanity with which it deals with this difficult subject. We give great thanks for that.

I reassure both the noble Lord, Lord Scriven, and the noble Baroness, Lady Thornton, that we absolutely take this report seriously. It does outline major issues in the culture of many maternity wards. That is a cultural challenge that is both recognised by the Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists, and something that they are working on very well indeed. But I accept that more can be done. In its application, the Government commit not only to implementing the recommendations at trust level but to ensuring that the message made very clearly in the Ockenden report is heard throughout the NHS system.

We are committed to a major investment in the education around midwifery, which includes the rewriting of curriculums, and the Better Births programme, which has already delivered enormous value. There will be a maternity programme review that will update the Better Births programme. There has also been a £9.4 million investment in maternity safety pilots, some of which will be focused on training and some of which will be on safety measures—exactly the kinds of measures that are alluded to in the report.

But the most challenging and, I think, moving element of the report is the stories of the parents themselves and how they were not listened to. This echoes the findings of the report by the noble Baroness, Lady Cumberlege, which, I think, has moved everyone in the House. Time and again we hear the same story, of how those who have witnessed wrong practices and poor culture in the NHS have had to fight the establishment so hard in order to have their voices heard. If any noble Lords heard Rhiannon Davies speak about her own experiences campaigning on this, who would not be moved by that?

We take on board very seriously the recommendations of the noble Baroness, Lady Cumberlege, for a patient safety commissioner. We acknowledge her amendment to the Medicines and Medical Devices Bill, and we look forward to the Report stage of that Bill in the new year.

I would also like to remind noble Lords that all maternity major incidents—certainly neonatal deaths, stillbirths and brain injuries—are now routinely referred to the Healthcare Safety Investigation Branch, which does an independent investigation. This is an important development since many of the incidents reported by the Shrewsbury and Telford Hospital NHS Trust report. HSIB is doing extremely important work, and I believe that this will be a very large improvement.

Both the noble Lord, Lord Scriven, and the noble Baroness, Lady Thornton, raised leadership. I reassure them both that we have put in place much stronger surveillance, both by the regulators—the CQC and others—and by NHS England to keep track of these sorts of incidents, so that we can much more quickly identify weak spots in the area.

On the question of staffing levels brought up by both noble Lords, I reassure them that the recruitment of midwives—3,000 were committed to in 2018—is going apace. We have committed to a major investment in marketing in order to ensure that we hit our targets on that.

The noble Lord, Lord Scriven, asked whether we were committed to change, or whether this report will sit on the shelf and gather dust. I reassure the noble Lord, and all noble Lords, that we are still very much committed to the maternity ambition to halve stillbirths, deaths and injuries between 2010 and 2025. We are already nearly half way there on that ambition, and we will work relentlessly to ensure that it is achieved.

[The Deputy Speaker (Baroness Fookes) (Con)]

We now come to the 20 minutes allocated for Back-Bench questions.

[Lord Patel (CB) [V]]

I declare an interest, because I was privileged to work for over 35 years in a maternity unit, with brilliant midwives and doctors—I was a lead obstetrician—to which the events described in this report were totally alien. So we have another report on the failings of maternity services. The root cause of this, as found in previous reports, is the unquestioning practice of regarding all pregnancies as low risk and striving for a natural birth. Does the Minister agree that, for better outcomes for the mother and her unborn baby, society should expect a better working relationship between midwives and obstetricians, while recognising their individual professionalism? This report should be the starting point to making that happen. The Minister mentioned that both Royal Colleges were working together to bring this about. They might be the solution but, if they are not, they will be the ones who are blamed next.

[Lord Bethell (Con) [V]]

My Lords, I pay tribute to the insight of the noble Lord, Lord Patel, who brings with him not only expertise as an obstetrician, but deep involvement in the patient safety agenda. I completely agree that collaboration and close working relationships between midwives and obstetricians absolutely benefit the collective care of mothers and babies. When that does not happen, and when agendas other than patient safety come into play—around natural births or what type of person should be present at a birth—it is absolutely to the detriment of the safety of both mother and child. I am absolutely determined that the Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists step up to their leadership role in resolving this cultural stand-off. As the noble Lord rightly put it, in almost every maternity centre in the country a fantastic service is provided by clinicians and nurses—but, when that chemistry goes wrong, patients suffer, and we cannot let that happen.

[The Deputy Speaker (Baroness Fookes) (Con)]

I do not see the noble Baroness, Lady Altmann, in her place, so I call the noble Baroness, Lady Blackstone.

[Baroness Blackstone (Ind Lab)]

My Lords, I declare an interest, as set out in the register, as the chair of the trustees of the Royal College of Obstetricians and Gynaecologists. As the Minister has admitted, this report makes shocking reading, so what steps will the Government take to monitor the improvements they are pledging for maternity services right across the country to avoid the tragedies that are revealed by this review? Will the Government commit to publishing the findings of any future evaluation and, in particular, data on the avoidable deaths and long-term disabilities that result from failures in the care of women during childbirth?

[Lord Bethell (Con) [V]]

My Lords, policy officials at the DHSC are working with both the CQC and NHS England on improving our surveillance and the publication of data, as the noble Baroness rightly points out. A key development in this area is the work by HSIB to investigate each and every death and major incident in maternity suites. That provides an absolutely invaluable resource to understand where and when things go wrong. We will continue to publish those reports as they happen and will learn lessons from their insights.

[Baroness Bennett of Manor Castle (GP)]

My Lords, much of this debate has already focused on the issue of staffing shortages in our NHS, particularly among midwives. I am sure that the Minister is aware of the survey last month from the Royal College of Midwives, which showed that 83% of midwives did not believe that their trust or board had enough staff to provide a safe service and 42% said that half or more of their shifts were understaffed. The Minister referred to recruitment campaigns and investment in future training, but the Ockenden review calls for an immediate focus on relationship building, training and things that will take a great deal of time and resources to deliver, where there are problems. I cannot see any alternative if we are to fill some of those gaps immediately. Training will take many years, but an overseas recruitment of midwives will bring in the staff we need to create the space to allow people to have that training—that time and reflection.

[Lord Bethell (Con) [V]]

My Lords, I respectfully disagree with the noble Baroness’s insight—the Ockenden review does not point the finger at staffing levels in relation to the problems; it points the finger at a number of items, particularly the cultural problems that emerge when differences of opinion between clinicians and midwives arise and where a culture of respect breaks down. Those cultural differences can be improved by what we would politely call education; it is essential that we invest in the right kind of education in order to bring midwives, obstetricians and gynaecologists closer together and to break down the hierarchical differences and the ideological differences about the best way to have a baby.

[Lord Lansley (Con)]

My Lords, as a Secretary of State responsible for the health service for some of this period—two years out of two decades—I share in the responsibility for what happened here and for the fact that it was not known about and that action was not taken sooner. I am sure that others who have been Ministers in the department over these two decades will feel likewise.

What is shocking is not only the individual trauma that parents have suffered but the scale of what the Ockenden review discloses—we are grateful to Donna Ockenden and her colleagues for persisting in trying to understand and disclose the scale of what has happened. I ask my noble friend about our responsibility, which was, of course, that there should be external oversight and action taken when these things go wrong. From my point of view, one of my objectives was that there should be more clinically led commissioning so that local clinicians would understand what was happening and have the power to step in.

The Ockenden report shows that, in May 2013, the clinical commissioning groups set up a review that, in October 2013, reported:

“The overall findings of the review demonstrate that this is a safe and a good quality service”.


I encourage Donna Ockenden and the department to look very carefully at how they could ensure that local clinicians responsible for commissioning take that responsibility seriously and act upon it.

[Lord Bethell (Con) [V]]

On behalf of the Chamber, I thank my noble friend for his touching testimony. He is entirely right; there are two CCGs in the local area: the Telford and Wrekin CCG and the Shropshire CCG. They did exactly what they should have done in 2013, launching an investigation into the levels of service at the Shrewsbury and Telford Hospital NHS Trust. It is not clear why the findings of that report turned out as they did; nor is it clear why other interventions, or potential interventions, by the CQC and other regulators did not get to the bottom of the problem. Those questions will be addressed in the second of Donna Ockenden’s reports, in 2021; there has not been time for them all to be addressed in the interim report, but there is much more to go into, and this is undoubtedly one of the important points she will need to address.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I declare an interest as a member of the GMC board. Nothing can excuse the repeated failures and the lack of compassion and kindness exposed by the review. What is so striking is the paragraph in the report that refers to the eight chief executives working in the trust over a period of 10 years and 10 chairs over 20 years —no wonder there is a leadership and governance issue in the trust. I ask the Minister: what on earth have NHS England, NHS Improvement and the CQC been doing? It seems that their interventions, which I suspect have been punitive in nature, have not provided the kind of support that is needed.

Does the Minister agree that we need a wholly new approach to this trust, which gives it high-level attention and provides stability in leadership—not a constant turnover because of an intervention by one or other of the many regulators that can do this—and above all, support from neighbouring services that can provide help? I suspect that this trust needs an awful lot of help to get out of this terrible situation.

[Lord Bethell (Con) [V]]

My Lords, I completely take on board the noble Lord’s observations. It is true that Donna Ockenden’s report alludes to the failure by senior leadership to monitor and intervene where clearly there were problems. However, let us not confuse correlation with causation. This was not caused by a failure of senior leadership, but by a breakdown in the basic management systems and culture of the maternity services within the trust. That should have been addressed by the senior leadership, but it was not necessarily caused by them. I completely endorse the observation of the noble Lord that neighbouring trusts have an important role to play in checking in and benchmarking behaviours. That is a point made very clearly in the Ockenden report, and one that I hope they will step up to.

[Baroness Uddin (Non-Afl) [V]]

I salute the courage of the parents of Kate Stanton Davies, Pippa Griffiths and so many others in their tenacious personal search for truth and justice. Donna Ockenden’s report was harrowing reading. The pain, trauma and inhuman disregard for the safety of baby and mother was palpable, profoundly damaging confidence and trust in maternity services. It made me relive my own decade-long failed attempt to seek information on whether my lengthy abandonment on a bed overnight after 48 hours of labour pain has anything to do with my now 42 year-old son’s brain damage and lifelong disabilities. I was dismissed constantly, admonished for “being an Asian mother too ashamed to have given birth to a disabled child”, which is far from the truth about a much-loved son.

Sadly, I was not alone, as the Ockenden report details. It has been repeatedly confirmed by so many others and by the first maternity advocacy scheme, which was set up in the 1980s to address the high postnatal mortality rate of mothers and babies among Bangladeshi, Pakistani, Somalian, Vietnamese and African women, whose maternity experiences, even today, remain inconsistent and patchy. Therefore, can I ask the Minister what consideration can and will be given to historic grievances in any future review of maternity services, given what the right honourable Jeremy Hunt in the other place, and Donna Ockenden, have said about the experience of mothers and babies highlighted being only the beginning of unearthing potential malpractice across England?

[Lord Bethell (Con) [V]]

I join others in paying tribute to the personal testimony of the noble Baroness. The story that she tells is extremely moving. One cannot think about the challenges and difficulties that she must have had since that awful night, which she so movingly describes. The report makes it clear that those with a BAME background have disproportionately high rates of difficulty at birth and in maternity services, something which undoubtedly we need to look at more carefully. However, the Ockenden report is not a historic grievances report, and that will not be the focus of our response.

[The Deputy Speaker (Baroness Fookes) (Con)]

Lord Mann? No? We will move on to the noble Baroness, Lady Stuart of Edgbaston.

[Baroness Stuart of Edgbaston (Non-Afl)]

My Lords, this is the second time in six months that this House has been exposed to quite harrowing tales of patients’ experiences in the NHS. I am glad that the Minister mentioned the report by the noble Baroness, Lady Cumberlege, and her call for a patient safety commissioner. Both the Ockenden and the Cumberlege report identified a problem with the culture in the NHS. We cannot go on having review after review. While it is important to listen to the patients’ experiences as part of putting things right, we must learn comprehensive lessons. Will the Minister therefore say just a little more as to how he intends to take the idea of the patient safety commissioner forward, and in particular how that patient safety commissioner will be independent of and not part of the NHS?

[Lord Bethell (Con) [V]]

My Lords, it would be premature of me to describe in too much detail how any patient commissioner may work, since we are half way through the Bill’s progress. But I would like to reflect on the very good arguments made by my noble friend Lady Cumberlege and her supporters during the Bill’s passage at Second Reading, in Committee and in the amendment-moving process. She has made very convincing arguments for how a patient safety commissioner can be an ultimate destination for those who have not found due process and a sympathetic ear elsewhere in the consideration of their grievances. It is entirely right that any commissioner, whether a victims’ commissioner or any other kind, should feel a strong sense of independence; that is a total benefit that we endorse in the provision of any commissioner. But commissioners are not enough; what we need is a change in culture. That is why Aidan Fowler, the DCMO looking at this, works so hard and why we have a patient safety agenda that works to address this at every level of hospital trusts.

[The Deputy Speaker (Baroness Fookes) (Con)]

All speakers have now been called, so we move to the next business without a break.

Health and Social Care Act 2008 (Regulated Activities) (Amendment) (Coronavirus) (No. 2) Regulations 2020

Lord Bethell Excerpts

Thursday 10th December 2020 Grand Committee

Moved by

[Lord Bethell]

That the Grand Committee do consider the Health and Social Care Act 2008 (Regulated Activities) (Amendment) (Coronavirus) (No. 2) Regulations 2020.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con) [V]]

My Lords, these regulations will provide an agile and robust regulatory environment for Covid-19 test providers. This is essential to ensuring that everyone has access to simple, effective and high-quality testing services that they can count on.

The Health and Social Care Act 2008 (Regulated Activities) (Amendment) (Coronavirus) (No. 2) Regulations 2020 will remove all CQC regulatory requirements for Covid-19 test services. Existing exemptions leave inconsistencies, resulting in some Covid-19 testing providers being within the scope of CQC regulation while other providers are exempt. We want to tidy this up. We will simplify the regulatory system for Covid-19 test providers, making it easier to understand for both suppliers and consumers.

The second SI is the Health Protection (Coronavirus, Testing Requirements and Standards) (England) Regulations 2020, which will impose requirements on private test providers to become accredited by the United Kingdom Accreditation Service and to attain specific stages of a process towards this accreditation within a given timeframe, starting on 1 January 2021.

I will say a word on context. Last week, the Medicines and Healthcare products Regulatory Agency recommended authorising Pfizer/BioNTech’s Covid-19 vaccine. While we wait for the vaccine deployment, testing and contact tracing remains one of the most effective ways of controlling the virus. During this important period, the more rapidly we can identify people at risk of infection, the quicker we can get life back to normal. In the last nine months we have built the largest diagnostic network in British history, which is helping us to tackle the spread of the disease and create the long-term capability to ensure that we are prepared to tackle future pandemics. However, we will only defeat the virus if the public and private sectors work together. The private sector has a critical role to play and has shown this time and again throughout this pandemic. I thank those in the diagnostics, logistics, data and associated industries for their contribution to our pandemic response.

In addition, it is not right to look to the NHS to provide every test for every circumstance. Private sector testing can support NHS Test and Trace by offering tests to those who have a reasonable need for testing but are outside the conventional clinical or epidemiological use cases. It can also help to drive innovation. The Government are therefore supporting the development of a private testing market. We want to ensure that everyone has access to simple, effective, high-quality and affordable testing services that they can count on, whether from the Government or a private provider.

As the demand for testing continues to grow and the number of providers increases, we need to reassure the public that quality control is as important as ever. That is why we want to support private providers to ensure that they can enter the market in a timely manner and meet the demand now without compromising the quality of their testing service.

There is currently a requirement in England to register with the CQC if you are involved in the removal of bodily cells, tissues or fluid samples or the analysing and reporting of these samples for Covid-19 testing. This requirement is subject to a number of exemptions, depending on the type of Covid-19 test sampling and analysis and on the entity undertaking the sample collection. This has resulted in inconsistent requirements for test providers, which have been a source of confusion. Test providers have emphasised the complexities surrounding entering the Covid-19 testing market and we have listened to them.

The first statutory instrument that I have laid before your Lordships will remove the requirement for Covid-19 testing providers to register with the CQC by exempting Covid-19 testing as a regulated activity under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. As the CQC is an English regulatory body, this does not apply in the other nations of the UK. These requirements will be removed, preventing confusion over the scope of regulations from causing restrictions in total testing capacity. It is imperative that a quality service is provided and testing capacity is not restricted; the change from CQC to UKAS will create an agile and robust regulatory environment.

The United Kingdom Accreditation Service, known as UKAS, is the sole national accreditation body in the UK, independent of, but appointed by, the Government. Accreditation by UKAS is the recognised gold standard for organisations offering test services. Since the beginning of the pandemic, we have been working with UKAS to ensure that Covid-19 test providers can access advice on quality assurance and become accredited. It has taken time to ensure that we get this right. Recognising this, and the urgent need for high-quality private testing, on 27 November my department and UKAS launched an adapted three-stage UKAS accreditation process for private test providers, to ensure that new and innovative providers can be accredited faster, without compromising on rigorous safety standards.

The second instrument that I have laid before your Lordships will require all providers offering test services on the English market to complete stage 1 of the UKAS accreditation scheme and attain UKAS applicant status from 31 December. After 31 December, new entrants to the market will be required to achieve UKAS applicant status before offering test services on the English market. The instrument also requires providers to achieve stage 2 UKAS appraisal and stage 3 UKAS accreditation statuses. Providers will need to complete stage 2 UKAS appraisal by 31 January 2021 or, if entering the testing market after 31 December, by whichever is later of 31 January 2021 or four weeks after gaining applicant status. Providers will then need to complete stage 3 UKAS accreditation by 30 June 2021 or, if entering the testing market after 31 December, by whichever is later of 30 June 2021 or four months after gaining appraisal status. Providers will be prevented from offering test services if they fail to meet these requirements. We have engaged closely with providers to ensure that these timelines are achievable.

Stage 1 UKAS applicant status requires applicants to self-declare that they meet 10 minimum standards, set by clinicians. Having gained applicant status, stage 2 UKAS appraisal requires test providers to demonstrate that they are progressing towards accreditation. The last stage, stage 3 UKAS accredited status, requires applicants to achieve full accreditation. As a result of the legislation that I have laid before your Lordships, test providers that provide tests commercially will be required to undergo this staged accreditation process. Employers that provide test services only to their own staff and organisations that supply tests at no cost will not be required to gain UKAS accreditation, although I would advise that they do so to ensure that their test services meet the highest possible standards. From 15 December, international arrivals will be able to opt in to “test to release” and all test services used for this purpose will be required to be working towards full accreditation.

Before I set out my final justification for these SIs, I must thank the JCSI, which scrutinised them so quickly. I will explain how the tests for the presence of antibodies are covered by these regulations. Current forms of tests for antibodies are not covered by existing CQC legislation and will not be covered by the UKAS legislation. As such, these regulations do not leave any regulatory gap for testing for antibodies that did not already exist. However, providers of tests for the presence of antibodies to Covid-19 can choose to apply for accreditation if they wish to do so.

Fundamentally, the new UKAS scheme will simplify the process of looking for a commercial test. Consumers will be able to identify providers capable of delivering a quality end-to-end test service, giving individuals and businesses the assurance they need. We strongly advise that consumers and organisations procure test services only from the gold standard providers which are on their journey to UKAS accreditation. They will be clearly listed on GOV.UK.

The legislation that I have introduced will simplify the testing landscape for test providers and regulate the market consistently, protecting consumers and helping test providers. I am enormously supportive of employers who have already chosen to begin testing their staff, but it must be done properly, using the right tests for the right purposes. These regulations will help employers and individuals to identify the right test services for their purposes and will help test providers to enter the market.

Finally, I apologise for not being with your Lordships in the Grand Committee this afternoon. I have been asked to isolate because a member of my household has tested positive. I am extremely grateful for noble Lords’ forbearance in this matter. I beg to move.

--- Later in debate ---

[Lord Bethell (Con) [V]]

I thank noble Lords enormously for an incredibly thoughtful discussion and I will seek to answer as many of their piercing and thoughtful questions as I can. If I miss any I will be pleased to write to noble Lords to clear up any loose ends. I will forgo the normal warm words at the beginning of such a speech and move directly to addressing the questions raised by noble Lords.

It is absolutely vital, as we open up our economy, that NHS supplies are saved for the situations where they are most needed. That is the principle behind what we are doing here today. To be clear: we are continuing to massively upgrade our commitment to testing. The PCR testing capacity for clinical and symptomatic testing is now reaching towards 800,000 a day—a colossal number—and the turnaround times have come down dramatically. In my household’s case, the test was taken at lunchtime yesterday and the result came at 7 am today—a phenomenal logistical achievement. We are also committed to the kind of community testing that the noble Baroness referred to, with the testing of asymptomatic individuals using technology such as the lateral flow devices that noble Lords will be aware of. This is exemplified by, but not limited to, the kind of testing in universities and schools that we have been piloting this autumn and will be rolling out in a very big way over Christmas.

As I have said before, we are investing massively in NHS testing, free at the point of use and available free of charge to all those who meet the use cases defined by the CMO. To ensure that this is possible, we need to enable the provision of new and innovative testing programmes that are as reliable and effective as possible. However, the NHS cannot possibly have pressure put on it to provide every test that every person in every part of this country wants at every time of the day. That has never been the case in this country and cannot be the case in the future. If tests are needed that are outside the use case or if someone is seeking to enable activities that fall outside the responsibility of our public health regime, it is right that those tests are sought from outside the NHS. It is therefore right that we seek to regulate the provision of those tests by the private sector.

The legislation that I have set out will ensure this, providing public confidence in testing and supporting private providers to enter the market. As I have set out, we need to create an agile regulatory environment for test providers, and we can do this by removing all CQC regulatory requirements for test providers, replacing them with the gold standard UKAS accreditation for commercial test providers. It is not our intention to cap the price, but it is our expectation that, given the billions of Covid tests now being manufactured around the world, the price will fall dramatically, and it is our intention to ensure that the quality meets clinical standards.

These measures will simplify the complex regulatory system for Covid-19 test providers; simplify the process around looking for a commercial test; and give individuals and employers essential assurances over the tests they procure. In response to the noble Lord, Lord Hunt, and my noble friend Lord Bourne, accreditation by the UKAS is the recognised gold standard for organisations that offer test services. My officials have worked really closely with colleagues at the UKAS to ensure that the accreditation scheme for Covid-19 test providers is as agile as necessary to deal with this growing market. The adapted three-stage approach is a direct result of this, ensuring that new and innovative providers can be accredited in a timely fashion, while preserving the UKAS gold standard. My officials will continue to work with the UKAS to ensure that this process is as seamless as possible, that test providers are given the support that they require to move through the scheme, and that correct enforcement procedures are in place.

Regarding contracting private industry to supply testing services, I hope that I will not shock either the noble Lord, Lord Hunt, or the noble Baroness, Lady Bennett, if I tell them that we are already engaged with the private sector in the purchasing of healthcare services for the NHS in the UK—not least in the provision of primary healthcare, which is conducted by the private sector in the form of GP practices, and through social care. That is also true in testing services. Time and again, throughout this pandemic, the private sector has shown that it has a critical role to play. While I note the comments of my noble friend Lady Wheatcroft, my experience of private-industry contractors has been largely positive; where there have been problems, we have to look at the whole partnership of government, universities, NHS and private industry for responsibility, not seek to scapegoat any particular party in this national collaboration. It is vital, as we look to open up our economy, that NHS Test and Trace supplies are focused where they are needed most. To ensure that this is possible, while utilising new testing innovations, the Government are supporting the development of the private testing market. To do this, we are bringing forward the regulations that I have laid before noble Lords today.

In response to the noble Lord, Lord Hunt, and to my noble friend Lady Altmann, I make it clear that the existing lengthy and costly on-boarding process is one reason for introducing this more agile system. The existing system is suited for major complex laboratories, many of which have been around for many years, and new entrants to the market are rare. We hope to have a more agile regime that will encourage innovation, but I will be glad to write to noble Lords with details of the intended costs.

My noble friend Lady Altmann is absolutely right to be concerned about fraud. She is right that there is a self-assessment at the beginning of the process, which is quicker and cheaper, to encourage new entrants and to avoid bottlenecks as this industry scales up. However, this is quickly augmented by a mandatory requirement to follow a rigorous on-boarding process with full administration. I am convinced that this will provide the necessary supervision of this industry, although I take her comments seriously and we will keep a careful eye on this threat. To answer my noble friend Lord Bourne, the test providers will be prevented from offering services if they do not have the right authorisations. If they break the rules, there are substantial—unlimited, I think —fines set by magistrates and applied to the company to ensure enforcement.

The legislation that I have introduced will simplify the regulatory landscape for test providers and regulate the market consistently. I thank Covid-19 test providers for their pivotal work at this time. We encourage the development of these sorts of test services in order to reduce pressure on the NHS and ensure that the test and trace programme can focus on situations where it is needed most; but it must be done properly, using the right tests, for the right price and the right purposes, and with the right enforcement regime. I beg to move.

Motion agreed.

Puberty-blocker Drugs

Lord Bethell Excerpts

Thursday 10th December 2020 Lords Chamber

[Lord Young of Norwood Green]

To ask Her Majesty’s Government what assessment they have made of the administration of puberty-blocker drugs to children under the age of 16.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con) [V]]

My Lords, the Government are committed to providing the best possible care for children and young people accessing gender identity services. Earlier this year, the National Institute for Health and Care Excellence was asked by NHS England to undertake a thorough review of the latest clinical evidence on the use of puberty suppressants and cross-sex hormones. An independent group, under the chairmanship of Dr Hilary Cass, will make recommendations about the existing clinical policies based on this evidence.

[Lord Young of Norwood Green (Lab) [V]]

My Lords, I wish to make my position clear: I am opposed to all forms of transphobia and transgender discrimination, but this should not override the rights of women as defined in law. I welcome the Minister’s statement on the guidance and the research, and I am sure he agrees with me on the importance of the NHS guidance. Does he also recognise that this needs to be ported? What actions will the Government take to ensure that local services, such as CAMHS, are sufficiently resourced to provide psychological support to all children and young people with gender-related distress?

[Lord Bethell (Con) [V]]

My Lords, the noble Lord puts his point extremely well. I share his concern for those with trans or gender concerns of any kind. I reassure him that provision of gender identity services at all levels is an absolute priority for the NHS. In the recent court case, we have seen a clarification of the guidelines attributed to some of those services, but it in no way mitigates against or suggests a lack of commitment on the part of the NHS to such services.

[Baroness Nicholson of Winterbourne (Con)]

Will the Minister confirm that since no baby can be born in the wrong body and human sex cannot be changed post- birth, the extensive plastic surgery, castration, double mastectomies and concomitant lifetime of heavy unnatural drug use that follow the introduction of puberty blockers are not the right way to assist a troubled child to gain mental stability and a contented and healthy future?

--- Later in debate ---

[Lord Bethell (Con) [V]]

I reassure my noble friend that people with gender dysphoria cannot access gender reassignment surgery under the age of 18, so young people are not eligible for the type of procedure that she describes. Gender identity services are clinically led and focus on enabling the young person to choose the path which suits their needs. They support children to explore their feelings, recognising that there is not a one-size-fits-all approach. This seems an appropriate approach in the circumstances.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, I warmly welcome the court ruling that children cannot consent to treatment to suspend puberty. Will the Minister join me in saluting the bravery of Keira Bell for taking this action and echo her message that being a tomboy or not liking stereotypically girly things does not make girls or young women any less female? Crucially, will he clarify that this ruling does not undermine the 1985 Gillick judgment giving young women the legal right to reproductive healthcare without parental consent and that the false and scaremongering misinformation circulated by certain organisations, including Amnesty International and Mermaids, is driven by a particular agenda rather than a concern for trans- gender people’s rights?

[Lord Bethell (Con) [V]]

My Lords, I salute the court’s thoughtful and lengthy judgment, which brought enormous clarity to an area which is very important but which has also caused concern and ambiguity. The court has made it clear that children under a certain age are not ordinarily able to make the kind of decisions that have previously been asked of them, but there are openings. No one under the age of 16 can now be referred on to puberty blockers unless a court rules that it is in the child’s best interest. These are helpful clarifications and we look forward to further work to clarify this area.

[Baroness Wheeler (Lab)]

My Lords, the mental health and well-being of young children and teenagers who present with gender dysphoria are paramount. Given the NHS England announcement on puberty blockers, what support are the Government giving to children and teenagers affected by the revised guidelines and their families and schools? On medical matters, will a young person under 16 concerned about gender dysphoria who approaches a GP continue to be covered by the duty of doctor-patient confidentiality?

[Lord Bethell (Con) [V]]

I reassure the noble Baroness that patient-doctor confidentiality remains paramount and is respected. To update her, the Tavistock has immediately suspended new referrals for puberty blockers and cross-sex hormones for under-16s. In future, they will be permitted only where a court specifically authorises it. I reassure the noble Baroness that those already on the programme will continue their medication until the review has been finalised.

[Baroness Barker (LD)]

The legal team that brought the recent case has, over recent years, brought several cases designed to oppose LGBT rights and to restrict the reproductive rights of women and girls. All those actions are consistent with campaigns run by organisations including the Heritage Foundation and the Alliance Defending Freedom—extreme evangelical right-wing American organisations. Will the Minister tell the House which NHS England boards and committees approved the amendment of the gender identity service specification on 1 December, prior to the court requiring them to do so, and in the light of the fact that this judgment can and will be appealed? If he does not have that information now, will he write to me?

[Lord Bethell (Con) [V]]

Well, my Lords, it is not appropriate for me to comment on those who have brought these cases, and outstanding judicial proceedings exist and are in place at the moment, so it is not possible for me to comment from the Dispatch Box in response to the noble Baroness’s remarks. All I can say is that the NHS, NICE and the Tavistock all have the interests of patients at their heart; we are not ideological about that. We are absolutely committed to the best interests of patients, and I would be glad to write to the noble Baroness to answer in any way that I can the questions she asked.

[Baroness Gale (Lab) [V]]

Is the Minister aware that the ruling and the NHS England response to it have caused significant uncertainty and distress among young people and families currently supported by the Tavistock clinic and those on its waiting list? Can the Minister say what steps the Government are taking to ensure continuation of care for young people currently in the care of the Tavistock who are affected by the NHS England response to the court ruling?

[Lord Bethell (Con) [V]]

I am sure that the noble Baroness’s testimony is entirely right, and it concerns me that anyone has any concerns in this matter. I reassure her that the Tavistock is doing absolutely all it can to reassure current patients and those who are on the referral list; its communications have been excellent throughout. The provision of puberty-blocker services to existing patients has continued, and it will remain in close contact with those patients as the review plays out.

[Lord Dobbs (Con) [V]]

My Lords, I hope this is an appropriate moment to reflect on the life of Jan Morris, that glorious writer who died just over two weeks ago. She was born a man, served in the British Army, fathered four children with her beloved wife Elizabeth and then transitioned from male to female in the 1970s—a challenge she bore with extraordinary humour and patience. So perhaps I may recommend that my noble friend reads all her books in his spare time. Would he agree that Jan Morris’s example of seeing the world in glorious colours, rather than narrowly in black and white, and of always showing kindness and tolerance even to those who disagreed with, and perhaps disapproved of, her, is an example that should inspire all sides of this debate and give comfort to those, in particular children and their parents, who find themselves struggling with the same difficult situation she did?

[Lord Bethell (Con) [V]]

[Inaudible]—to be more affected by their warmth and kindness. Jan was an absolute model of warmth and kindness. Having worked in the nightclub industry, I have met, worked with and enjoyed the company of many trans people, which has always proved to be an extremely uplifting experience. I am a massive supporter of the trans movement in the round.

[The Deputy Speaker (Lord Lexden) (Con)]

My Lords, the time allowed for this Question has now elapsed.

Health Protection (Coronavirus, Testing Requirements and Standards) (England) Regulations 2020

Lord Bethell Excerpts

Thursday 10th December 2020 Grand Committee

Moved by

[Lord Bethell]

That the Grand Committee do consider the Health Protection (Coronavirus, Testing Requirements and Standards) (England) Regulations 2020.

Relevant documents: 37th Report from the Secondary Legislation Scrutiny Committee and 34th Report from the Joint Committee on Statutory Instruments (special attention drawn to the instrument)

Motion agreed.